Migraines are one of the most common neurological disorders globally and are considered to be the second most reported cause of disability.
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What are migraines?
Migraines are a common headache disorder characterized by neurological and autonomic symptoms alongside pain. They often range from moderate to severe intensity, and migraineurs can experience an intense throbbing pain affecting one particular side of their head.
Aside from the pain, those with migraines may also report experiencing a range of other symptoms, including a heightened sensitivity to light or sound, feeling nauseated or vomiting. Some experience auras with alterations in vision, sensation, or speech.
Migraines typically develop over a period of distinct stages. However, this may differ from person to person.
Stage 1: Pre-headache – Also known as the prodromal stage, patients will often report changes in behavior, levels of energy, affect, and appetite. These changes can be noted days or a number of hours before the onset of a migraine.
Stage 2: Aura – Those who experience migraines with aura typically experience migraine warning signs.
Stage 3: Headache – A throbbing pain on one side of the head is experienced, alongside feelings of nausea, and sensitivity to loud noise and bright lights. This stage can last between four hours and three days.
Stage 4: Resolution – After the headache and accompanying symptoms have subsided, patients may feel tired for the following days.
In addition to having four main stages of progression, there are several types of migraines. Each varies depending on the presence or absence of an aura and headache, such as migraine with aura and migraine without aura.
Migraine with aura vs. migraine without aura
One of the main differences between migraines with aura compared to those without aura is that in the former, migraineurs report experiencing warning signs preceding the onset of their migraine.
Migraine with aura
It is thought that approximately a third of those who have migraines will have one of the following warning signs referred to as an aura:
- Speaking impairments;
- Feeling off-balance or dizzy;
- Visual issues – for example blind spots in vision, or seeing zig-zags and flashing lights;
- Feelings of numbness and tingling;
- More rarely, loss of consciousness.
Research has found that aura-linked symptoms normally develop over a 5-minute period and can last for approximately an hour. Some may report auras preceded by a mild headache, while others may develop no headache at all. However, patients who often have migraine with aura may also experience migraines without auras. In the latter case, for some, trigger factors are more likely to be reported.
Migraine without aura
Migraines without aura are reported to affect two-thirds of all migraineurs. Those that experience migraines typically just experience pain and any associated symptomology previously discussed. However, due to the lack of aura symptoms, the onset of their migraines is not as predictable.
Etiological differences between migraine with and without aura
Researchers have become extremely interested in the proposed etiological and biological differences between migraines with aura and migraines without aura.
This research has been led by the discovery that those with migraines with aura are more likely to experience ischemic strokes compared with those who experience migraines without aura. This may demonstrate that the two types of migraines may have different biological mechanisms.
There are a number of treatment options that can be taken by migraineurs in order to reduce migraine symptoms acutely or to prevent them or reduce their frequency and severity. Typically, the same treatment options are offered for those that experience migraine with and without aura.
For relatively mild episodes, nonspecific analgesics such as anti-inflammatories can be used. Medications specifically prescribed for migraines include triptans. For those that experience chronic migraines frequently, drugs such as beta-blockers, antidepressants, anticonvulsants, and a new class of monoclonal antibody medications can be prescribed as preventative agents.
NHS (2019). Migraine: Overview. https://www.nhs.uk/conditions/migraine/
Wang J., Zhang B., Shen C., et al. (2017). Headache symptoms from migraine patients with and without aura through structure validated self-reports. BMC Neurology. DOI: 10.1186/s12883-017-0973-4
Puledda F., Messina R., Goadsby P. J. (2017). An update on migraine: current understanding and future directions. Journal of Neurology. DOI: 10.1007/s00415-017-8434-y
Hansen, J., & Charles, A. (2019). Differences in treatment response between migraine with aura and migraine without aura: lessons from clinical practice and RCTs. The Journal of Headache and Pain. thejournalofheadacheandpain.biomedcentral.com/.../s10194-019-1046-4